midterm fluid Flashcards
normal urine output
infant 2ml/kg/hr
child 1ml/kg/hr
Adolescent 0.5ml/kg/hr
Differences in Neonates & Infants
Proportionately higher ECF
High daily fluid requirement with little fluid volume reserve = vulnerable to dehydration
Proportionately greater daily losses; More dependant on adequate intake
Larger body surface area (BSA)
High respiratory & metabolic rates
Immature kidneys = cant concentrate urine = excrete more than normal
don’t produce tears
Na is normal 130-150 mEq/L
Isotonic dehydration
equal balance and loss of electrolytes (Na) and fluid from ECF
risk of shock
Greater loss from ECF because more fluid there
Hypotonic /hyponatremia dehydration
loss of more electrolytes than fluid
more solute in ICF
shift ECF -> ICF = cells swell
risk to brain cells, CNS symptoms
Na low <130
tx
-Decrease H20 intake - to try to balance solute concentration & allows kidneys to correct imbalance by excreting excess water
-Hypertonic Saline IV solution - to shift fluid out of cells
hypertonic dehydration hypernatremia
Gain of more Na than water
loss of more water than Na
Na high >150
ICF -> ECF = physical symps less obvious
most dangerous
shock less apparent
seizures dt brain cells shrinking
fluid loss
magnitude of fluid loss described as a % (5, 10, 15) & ascertained by comparison of pre-illness weight & current weight.
mild <3%
mod 3-9%
severe >9%
pre-illness wt - current wt
————————————– x 100 = __%
pre-illness wt
mild up to 5%
mod 6-9
severe 10+
dehydration clinical manifestations
Earliest detectable sign is usually tachycardia, followed by dry skin & mucous membranes, sunken fontanels, signs of circulatory failure (coolness & mottling of extremities), loss of skin elasticity, & delayed capillary filling time.
dehydration causes from loss of Na
vomiting, diarrhea, NG suction, hemorrhage, burns
LBW infants under radiant warmers, adrenal insufficiency, “third space” accumulation (e.g. peritoneal cavity) & overuse of diuretics
Compensation
Early:
-vasoconstriction, tachy cardia. Normal BP
moderate: systolic BP falling
Late:
-BP falls -> hypoxia, metabolic acidosis
-renal compensation
ADH =conserve fluid
Renin angiotensin = vasoconstriction
Aldosterone = Na retention
Peds late and significant sign
Low BP is late sign & may herald onset of cardiovascular collapse.
Stressors of Hospitalization for Children
Infant- separation anxiety
toddler - separation anxiety
preschooler - separation anxiety
school aged- loss of control, fear of pain
adolescent- loss of coontrol
Pain scale.
FLACC - <3 years or non verbal
faces - >3 yrs
pain rating scale - 5+ yrs
non-communicating child
nursing care for hospitalized child
Promote sense of security and control
use play
educate to prepare for painful prcedures
